红细胞沉降率极端升高的临床观察  

Clinical observation of extremely elevated erythrocyte sedimentation rate

作　　者：许汪斌[1] 赵伟 钱冉[1] 肖李乐云[1] 王英[1] 代冬梅[1] 祝艳翠[1] Xu Wangbin;Zhao Wei;Qian Ran;Xiao-Li Leyun;Wang Ying;Dai Dongmei;Zhu Yancui(Department of Intensive Care Unit,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan,China)

机构地区：[1]昆明医科大学第一附属医院重症医学科,云南昆明650032

出　　处：《中华危重病急救医学》2021年第5期613-617,共5页Chinese Critical Care Medicine

基　　金：云南省科技计划项目(2018ZF009)。

摘　　要：目的分析红细胞沉降率(ESR)极端升高(ESR≥100 mm/1 h)患者的临床特征,以期提高临床医师应用ESR辅助诊治疾病的能力。方法回顾性分析2019年1月1日至12月31日昆明医科大学第一附属医院实验室检查ESR≥100 mm/1 h的患者临床资料。收集患者年龄、性别、临床诊断、入院后首次ESR值及入院24 h内的血常规、肝功能、肾功能、凝血功能和C-反应蛋白(CRP)等指标。根据2019世界卫生组织(WHO)人类年龄划分新标准将患者分为青年组(18~65岁)、中年组(66~79岁)、老年组(≥80岁);根据临床诊断将患者分为感染性疾病组、血液系统疾病组、自身免疫性疾病组、肾功能衰竭组及其他系统疾病组;分析ESR极端升高在上述疾病中的分布情况以及ESR极端升高与各项实验室检查指标的相关性。结果①共纳入429例ESR≥100 mm/1 h的患者,男性236例,女性193例;男性与女性患者ESR值比较差异无统计学意义〔mm/1 h:108.00(103.00,119.75)比117.00(105.50,140.00),P=0.234〕。②429例患者年龄18~98岁,平均(53.70±18.70)岁;青年组310例,中年组87例,老年组32例。青年组ESR值明显低于中年组和老年组〔mm/1 h:108.00(103.00,120.00)比119.00(107.00,140.00)、120.00(110.25,140.00),均P<0.01〕。③429例ESR极端升高患者主要诊断为感染性疾病(157例,占36.6%),其次为血液系统疾病(127例,占29.6%)、自身免疫性疾病(74例,占17.2%)等。在感染性疾病中肺部感染者占58.0%(91/157);在血液系统疾病中造血干细胞疾病者占45.7%(58/127),淋巴细胞和浆细胞疾病者占37.0%(47/127),红细胞疾病者占11.0%(14/127);在自身免疫性疾病中弥漫性结缔组织病者占75.7%(56/74)。④Spearman相关性分析显示,所有患者ESR极端升高与红细胞计数(RBC)、血红蛋白(HB)、血细胞比容(HCT)水平呈负相关(ρ值分别为-0.395、-0.381、-0.383,均P<0.01),与纤维蛋白原(FIB)水平呈正相关(ρ=0.345,P<0.01);同时检测ESR和CRP的266例患者ESR�Objective To analyze the clinical features of adult patients with extremely elevated erythrocyte sedimentation rate(ESR,ESR≥100 mm/1 h),so as improve the ability of clinicians to use erythrocyte sedimentation rate to assist in the diagnosis and treatment of diseases.Methods A retrospective cohort study was conducted to examine the clinical data of patients with ESR≥100 mm/1 h admitted to the First Affiliated Hospital of Kunming Medical University from January 1st 2019 to December 31st 2019.The age,gender,clinical diagnosis,first ESR level after admission,blood routine,liver function,renal function,coagulation function and C-reactive protein(CRP)within 24 hours after admission were collected.Patient cohorts were divided into youth group(18-65 years old),middle-aged group(66-79 years old)and elderly group(≥80 years old)according to the new standards of human age classification of World Health Organization(WHO)2019.Patient cohorts were also divided into infectious disease group,hematological disease group,autoimmune disease group,renal failure group and others according to their respective clinical diagnosis.The distribution of extremely elevated ESR in each group,and the correlation between ESR and various laboratory indicators were analyzed.Results①Among 429 patients with ESR≥100 mm/1 h,there were 236 males and 193 females.There was no significant difference in ESR levels between males and females[mm/1 h:108.00(103.00,119.75)vs.117.00(105.50,140.00),P=0.234].②The age of 429 patients ranged from 18 to 98 years old,the average age was(53.70±18.70)years old.There were 310 cases in the youth group,87 cases in the middle-aged group and 32 cases in the elderly group.The ESR level of the young group was significantly lower than that of the middle-aged group and the elderly group[mm/1 h:108.00(103.00,120.00)vs.119.00(107.00,140.00),120.00(110.25,140.00),both P<0.01].③The main diagnoses associated with extremely elevated ESR were infectious diseases[157 cases(36.6%)],hematological system diseases[127 cases(2

关 键 词：红细胞沉降率 临床特征 肺部感染 血液系统疾病 血常规 

分 类 号：R446.113[医药卫生—诊断学]